Wednesday

Jan 17, 2018 at 12:01 AMJan 17, 2018 at 1:35 AM

Women with low-risk pregnancies would not have to deliver at hospitals to get epidurals or to have cesarean sections, under legislation overwhelmingly approved by a House panel Tuesday despite safety concerns raised by Florida hospitals.

Bill sponsor MaryLynn Magar, R-Tequesta, touted the proposal (HB 1099) as a potential way to help lower health-care costs while giving pregnant women more choices of health-care provides for labor and delivery. She also said it potentially could be an attractive option for the Medicaid program.

"I could see that with 62 percent of our births being paid for by Medicaid, this could also be a great savings for the state down the road," she said.

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Florida Hospital Association lobbyist Martha DeCastro said her members are concerned that the bill doesn’t ensure adequate quality of care.

"Our concern is quality and patient safety," she said, while also telling the House Health Quality Subcommittee that the association has agreed to work to improve the bill as it moves forward.

Women in Florida can plan to have babies at three types of locations: home, a licensed birth center or a hospital. Birth centers currently are not authorized to keep patients beyond 24 hours or to provide epidurals or cesarean sections. They also are limited to treating only women who are considered to have low-risk pregnancies.

Magar’s bill would eliminate the surgical and length-of-stay restrictions as well as the ban on epidurals. "Advanced" birth centers would be allowed to keep women up to 48 hours following vaginal deliveries and 72 hours following c-sections.

The state had 221,038 births at hospitals in 2016 and another 1,724 births at birth centers, according to the Florida Department of Health. Another 2,050 births were planned at home.

The Safety Net Hospital Alliance of Florida represents the state’s teaching and children’s hospitals as well as 11 regional perinatal intensive care centers that treat the sickest women. Jan Gorrie, a lobbyist for the group, said regional perinatal intensive care centers are reviewing birth data and transfer data and will report findings back to the Legislature.

Gorrie also said the association is worried that if the advanced birth centers attract a lot of women, it may have an adverse impact on the ability of hospitals to offer residency programs in obstetrics or potentially even pediatrics. Residency programs are offered upon graduation from medical school and usually last between three years and five years.

Magar’s proposal is the second bill that has moved forward in the House that would expand the ability of non-hospital providers to treat low-risk patients.

The full House on Friday approved a bill (HB 23) that would allow patients to stay in ambulatory surgical centers for up to 24 hours, ending a long-standing prohibition on overnight stays, and also would authorize so-called "recovery care centers," where patients could stay up to 72 hours after undergoing surgical procedures.

House leaders have championed those proposed changes for years, but the Senate has been reticent to move forward. In a sign that things may change this year, the Senate Health Policy Committee approved a measure (SB 250), which would authorize the overnight stays for ambulatory surgical centers. The bill does not include allowing recovery care centers.

The birth center issue, however, has emerged this year.

With offices in Tampa and in the Orlando area, Women’s Care Florida has 67 outpatient centers across the state and delivers more 13,000 babies annually. CEO Andrew Mintz told the House panel that the physician group is interested in developing an advanced birth center if authorized by the Legislature.

"Each day, we get more and more pressure from employers, from patients and from payers to really hit the goals of what they call the triple aim in health care," which, Mintz said, is improving quality, lowering costs and improving the patient experience.

Though she supported the bill on Tuesday, Rep Amy Mercado, D-Orlando, said she had concerns about the bill’s safety precautions and noted that births can get complicated even with women who are considered low risks.

She had three cesarean sections under the age of 24 and was considered low risk. Yet an adverse reaction to anesthesia, following an unsuccessful attempt at a vaginal birth following a c-section, sent her and her infant daughter into distress.

"You’re not guaranteed low-risk delivery because it was a low-risk pregnancy," she said.

Rep. Amber Mariano, R-Hudson, said she would eventually like to see a requirement that the facilities be located within a certain distance from hospitals. Currently, there are no requirements for birth centers to be located near hospitals and, therefore, they are not in the bill, she said.

Midwife Association of Florida lobbyist Ron Watson said his members are OK with the bill but think that the centers should be given a different name.

"They thought it should be titled something else," Watson said. "Birthing centers have historically kind have been associated with midwife practice, and so they suggested it be called a maternal ambulatory surgical center or some other kind of name so there would be a little bit less confusion."

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